A recently published Nuffield trust report offers a fascinating insight into the routes that cancer patients take through the care system. In an era that promotes integrated care we all accept that caring for a person extends beyond one organisation; and treatment for cancer may include primary, community and social care on top of acute hospital activities.
However, it is notoriously difficult to see what services patients are using as our information systems are usually so disjointed. Yet as this report shows it is now possible to secure users data linkage to look across these silos.
One of the positive benefits of computerised information systems is becoming apparent in that they make it possible to link together records to show how people use care services. This approach can help shed new light on what is happening to patients, not just during a course of hospital-based treatment, but also across other care services.
10 per cent of people received a local authority social care assessment within three months of being diagnosed with cancer
This is just what we did with the Nuffield Trust team in order to look at what types of social care support people with cancer were receiving. In particular, we wanted to find ways to look at the longer term care needs of people by assessing what range of services they were accessing some-time after initial diagnoses and treatment.
So we studied anonymised records of the primary, secondary and social care use of 8,072 people with a first diagnosis of cancer from two areas of England, for a year before diagnosis and up to 18 months after.
By tracking patient activity before and after diagnosis, we could see some of the patterns that you might expect in health care increasing in activity after diagnosis. The results showed clear evidence of the social services response to a person being diagnosed with cancer: 10 per cent of people received a local authority social care assessment within three months of being diagnosed with cancer (compared with seven per cent receiving care in the year before diagnosis).
This varied from three per cent of those with skin or breast cancer to 20 per cent of those with brain/central nervous system (CNS) tumours.
We were also able to see the balance of hospital resources that were used. 15 months after diagnosis, people with cancer had; 60 per cent more Accident & Emergency (A&E) attendances, 97 per cent more emergency admissions, four times as many outpatient attendances and nearly six times more elective admissions than expected – based on a population of the same age/gender.
A similar pattern was seen for GP visits, with cancer survivors having 50 per cent more contact than expected, 15 months after diagnosis.
Although people with cancer incur significant costs across care sectors, use of social care services and overall costs were relatively modest and demonstrated differential patterns in response to diagnosis. Furthermore, there was a shift of costs away from social care following diagnosis.
This shift may reflect the mobilisation of social care provided by the voluntary sector, which will not be captured by statutory records analysed in this study. However, the findings demonstrate the importance of understanding the long-term needs of cancer patients across both health and social care services for service planning, funding, and assessing intermediate outcomes.
If better integration of care services across the NHS and social care is to become a reality, then this type of analysis is going to be absolutely vital to planning and delivering the right services – not just in one hospital but across the “whole” health and social care system.
Dr Adam Glaser is a Consultant at Leeds Teaching Hospitals NHS Trust. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.
Glaser A (2014) ‘Social care and cancer: tracking care across service boundaries’. Nuffield Trust comment, 2 June 2014. https://www.nuffieldtrust.org.uk/news-item/social-care-and-cancer-tracking-care-across-service-boundaries